Authority to post a sticking point for PCEHR pathology reports

Written by Kate McDonald on 30 June 2014.

The Department of Health has released two consultation papers on proposed models for uploading pathology and diagnostic imaging reports to the PCEHR and is looking for feedback to refine the models further.

The papers detail in full where discussions on uploading pathology and imaging data got up to before the PCEHR review was announced last December, as well as proposed design principles and sample pathology report and diagnostic imaging report views.

One area of interest is the technical requirements behind the proposed authority to post (ATP), a message that would be sent to the pathology provider from the referring healthcare practitioner that a result can be posted as an immutable PDF to the consenting patient's PCEHR.

Pathology providers will also be responsible to removing older or superseded pathology reports from the system.

The paper states that it is recognised that more work needs to be done with clinicians and software vendors to ensure that design of the ATP workflow in clinical systems integrates well with existing practices. Medico-legal issues are also a major concern.

Pathology providers have in the past raised the issue that their current secure messaging systems only support one-way, outbound messaging, meaning a cost-effective solution will need to be provided for both referring doctors and pathologists to set ATP up.

Pathology software vendors have also advised that they might need technical support with CDA documents, with which they are reasonably unfamiliar.

The plan for diagnostic imaging is that only the reports will be uploaded to the PCEHR, not the images themselves. The consultation paper states that no consensus had been reached in discussions with the sector last year, before consultation was paused when the review was announced.

“There are still outstanding issues around the clinical workflow and the technical changes that would be required to support the proposed ATP model,” the diagnostic imaging consultation paper states.

Similar issues face radiology practices as those facing pathology providers in terms of technical capabilities around ATP, and the suitability of the proposed ATP model was not agreed to in the last round of consultation.

Two-way messaging is a barrier, but there is also the problem that software vendors for diagnostic imaging are predominantly based overseas and therefore not focused on Australian-specific requirements.

“As a consequence any changes required to get diagnostic imaging reports into the PCEHR may take some time,” the paper states.

“While broad consensus was not reached on the suitability of the ATP model there was agreement from a technical perspective that any new messaging capability required for ATP should be based on the existing HL7 messaging framework.

“It was also agreed that a new national technical specification to support the electronic transfer of ATP messages between healthcare providers and diagnostic imaging providers would be required. It is proposed that NEHTA will draft a new National ATP messaging specification based on input received during consultation.”

An alternative model for diagnostic imaging was put forward, in which information about the imaging event was also uploaded to the PCEHR. This information would include the date, location, type of procedure and details of the imaging facility. As this is not necessarily sensitive information, it might negate the need for an ATP.

Samples of both pathology report and diagnostic imaging report views are available as appendices in the consultation papers.

The department is requesting feedback to the consultation papers by email by July 18. Workshops are also being held in Melbourne on July 8 and 9.